New vaginal ring to prevent HIV, pregnancy is safe: Study

An experimental vaginal ring designed to prevent pregnancy and HIV looks safe, according to an early stage study.

The ring is designed to provide 90 days’ protection at a time. The dual-purpose ring releases the antiretroviral drug dapivirine and the contraceptive hormone levonorgestrel, said researchers led by Dr Sharon Achilles, of the University of Pittsburgh School of Medicine.

This small, 14-day trial involving 24 women who were not pregnant and not infected with HIV was the first clinical study of the ring.

“We are very encouraged by our findings in this first-in-human study of the dapivirine-levonorgestrel ring,” said Achilles, an assistant professor of obstetrics, gynecology and reproductive sciences.

Its use resulted in sufficient levels of levonorgestrel to prevent pregnancy and adequate levels of dapivirine to reduce risk of HIV infection, the researchers noted.

There were no safety concerns, and the ring was well-tolerated, according to the Microbicide Trials Network study.

The researchers have started a second Phase 1 trial in which women will use the ring for 90 days.

“With a second study underway, we are another step closer to potentially having an easy-to-use product that can provide safe and effective, long-acting protection against both HIV and unintended pregnancy,” Achilles said in a network news release.

The research was funded by the US National Institutes of Health and presented Wednesday (Oct 24) at an HIV prevention conference, in Madrid, Spain.

Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.

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Suicide can’t be predicted by asking about suicidal thoughts : Study

Most people who died of suicide deny they experience suicidal thoughts when asked by doctors in the weeks and months leading up to their death, a major Australian study has found.

The findings, co-authored by clinical psychiatrist and Professor Matthew Large from UNSW’s School of Psychiatry, Sydney that published in the journal BJPsych Open The meta-analysis challenge the widely-held assumption that psychiatrists can predict who will suicide by asking if they are preoccupied with thoughts of killing themselves.

The study showed that 80% of patients who were not undergoing psychiatric treatment and who died of suicide reported not to have suicidal thoughts when asked by their psychiatrist or GP.

“If you meet someone who has suicidal ideation there is a 98 per cent chance that they are not going to suicide,” said Professor Large, an international expert on suicide risk assessment who also works in the emergency department of a major Sydney hospital.

“But what we didn’t know was how frequently people who go on to suicide have denied having suicidal thoughts when asked directly,” he added.

“This study proves we can no longer ration psychiatric care based on the presence of suicidal thoughts alone. We need to provide high-quality, patient-centred care for everyone experiencing mental illness, whether or not they reveal they are experiencing suicidal thoughts,” Professor Large said.

About one in 10 people will have suicidal ideation in their lifetime. But the study showed suicidal ideation alone was not rational grounds for deciding who gets treatment and who does not, Professor Large said.

“We know that suicide feeling is pretty common and that suicide is actually a rare event, even among people with severe mental illness,” Professor Large added.

Suicidal ideation tells us an awful lot about how a person is feeling, their psychological distress, sometimes their diagnosis and their need for treatment but it’s not a meaningful test of future behaviour.

Suicidal feelings can fluctuate rapidly and people may suicide very impulsively after only a short period of suicidal thoughts.

But, people had good reasons not to disclose thoughts of suicide, fearing stigma, triggering over-reactions or upsetting family and friends, and being involuntarily admitted for psychiatric treatment, Professor Large said.

Professor Large emphasized that clinicians should not assume that patients experiencing mental distress without reporting suicidal ideas were not at elevated risk of suicide.